Provider Demographics
NPI:1356817894
Name:COZE HEALTH MEDICAL, LLC
Entity Type:Organization
Organization Name:COZE HEALTH MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:B
Authorized Official - Last Name:O'DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-379-3456
Mailing Address - Street 1:156 SAGAMORE PKWY W STE A
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-1569
Mailing Address - Country:US
Mailing Address - Phone:765-204-1122
Mailing Address - Fax:765-205-8322
Practice Address - Street 1:156 SAGAMORE PKWY W STE A
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1569
Practice Address - Country:US
Practice Address - Phone:765-204-1122
Practice Address - Fax:765-205-8322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01066964AOtherINDIANA PROFESSIONAL LICENSING AGENCY
IN01072209AOtherINDIANA PROFESSIONAL LICENSING AGENCY